Quality of care may be key to cutting long-term cost

September 28, 2012

National health care reform presents an opportunity to improve the way California delivers and measures the quality of long-term care and save money along the way, according to organizers of a long-term care conference last week in Sacramento.

The long-term care population - often elders with multiple chronic conditions, multiple providers and sometimes dozens of medications - is an expensive one to treat. According to Lisa Shugarman, director of policy at the SCAN Foundation, which sponsored the conference, national reform gives California a chance to change the way it handles long-term issues.

"We are hoping to improve, not just the quality of long-term supports and services," Shugarman said, "but also the quality of the system as a whole."

In order to put more focus on quality, Shugarman said, the first step now is to figure out how to rate it.

Right now, most quality measures are transactional - such as recording whether or not staff members administered aspirin within a certain number of minutes with a heart attack patient, Shugarman said.

"There's a different set of data needed with the patient-centered approach," she said, to measure such things as satisfaction and medication compliance.

That's one of the things California health officials are expecting to do, according to Neal Kohatsu medical director for the Department of Health Care Services, despite California's recent cuts to health care programs.

"We all recognize the fiscal pressures on the system, but also we need to expect more quality in our health care system," Kohatsu said. "We can do both," he said, meaning that the state health care system can make both financial savings and quality improvements at the same time, he said. "But to do that, we have to bring about a culture change for health care."

That means moving from process measures to outcomes, he said, from a cost perspective to a value-based system and from a silo method of delivering services to a more integrated approach.

Focusing on quality is the ticket to achieving all of that, he said. "The key is, we have to move from a budget to a quality metric," he said.

For instance, Kohatsu said, Medi-Cal pays for about half of all births in the state. "So if we can improve birth quality (among Medi-Cal patients), that would have a statewide impact," he said.

The dual eligibles project, formally known as the Coordinated Care Initiative, is an example of how the state hopes to improve quality and cut costs, Kohatsu said. He said the state's neonatal quality improvement initiative has been successful at reducing bloodstream infections in neonatal intensive care units, an effort that saves money and lives, he said.

"There are ways to reduce per capita cost while improving quality," Kohatsu said. "Now, that may seem contradictory, but it's not only doable - it's also essential that we do it."